Problems in Narrowing the Quality Chasm

Throughout the last decade the American Public Health Association has sponsored sessions on the quality and safety of health care in the United States, yet only modest progress has been made to improve health care quality and safety in the United States. This special session will assess progress in quality and safety improvement in both the public and private sectors.

Many efforts have been made across the nation to narrow the quality chasm, and to improve both public and private health care in hospitals, and in community-based, grassroots initiatives at regional and local levels to improve quality. Examples will be described, and lessons learned will be summarized. Recommendations will be made for improving the quality and safety of health care and its relationship to population health in the second decade of the 21st century.

Next, we will ask what we can learn from the quality enterprise in hospitals, ambulatory, and community settings that would be instructive for improving community health. We will compare healthcare performance measurement in hospitals and community health settings to the public health surveillance system, to established public health goals (e.g., Healthy People 2020), and to approaches for performance improvement in the public health sector. We will discuss what types of measures could enhance population health by encouraging the integration of the public and private health systems in the U.S. Examples will be taken from the national priorities partners' goals. A community health index will also be discussed.

Finally, we will evaluate what types of public investments are needed to support performance measurement, reporting, and the quality improvement enterprise. In particular, public investments should focus on priority setting, measurement endorsement, and measurement maintenance, including the evaluation of the efficacy of measures used for improvement. Also, public support for research is needed to better understand which quality improvements make the biggest difference in helping health care providers, health care institutions, and public health officials to deliver higher quality, more affordable, care to improve our nation's health.